Catamenial pneumothorax is a action of collapsed lung (pneumothorax) occurring in affiliation with menstrual periods (catamenial refers to menstruation), believed to be acquired primarily by endometriosis of the pleura (the film surrounding the lung).¹

Classification

Catamenial pneumothorax is the a lot of accepted anatomy of thoracic endometriosis syndrome, which aswell includes catamenial hemothorax, catamenial hemoptysis, catamenial hemopneumothorax and endometriosis lung nodules, as able-bodied as some aberrant presentations.

Symptoms and signs

Onset of lung collapse is beneath than 72 hours afterwards menstruation. Typically, it occurs in women age-old 30-40 years, but has been diagnosed in adolescent girls as aboriginal as 10 years of age and column menopausal women (exclusively in women of menstrual age) a lot of with a history of pelvic endometriosis.

Pathophysiology

Endometrial tissue attaches aural the thoracic cavity, basal chocolate-like cysts. Generally the parietal pleura is involved, but the lung itself, the [visceral pleura|visceral layer]], the diaphragm, and added rarely the tracheobronchial tree may aswell be afflicted.² How this endometrial tissue alcove the bust charcoal enigmatic. Defects in the diaphragm, which are begin generally in afflicted individuals, could accommodate an access path, ³ as could microembolization through pelvic veins ⁴.

The cysts can absolution blood; the endometrial cyst "menstruates" in the lung. Air can move in by an alien mechanism. The claret and air could cause the lung to collapse (i.e. catamenial hemopneumothorax).⁵

Diagnosis

Diagnosis can be hinted by top ceremony ante of lung collapse in a woman of changeable age with endometriosis. CA-125 is elevated. Nowadays, video-assisted thoracoscopy is acclimated for confirmation.

Treatment

Pneumothorax is a medical emergency because it comes with astringent pain and decreased lung function. A chest tube should be amid afterwards analytic assessment. This releases the air and menstrual blood, and the lung can re-expand.

Surgery, hormonal treatments and accumulated approaches accept all been proposed, with capricious after-effects in agreement of abbreviate and continued appellation outcome.⁶ Surgical abatement of the endometrial tissue should be endeavoured during menstruation for optimal visualisation of the cyst.⁷ Pleurodesis may aswell be helpful. Menstruation and accompanying lung collapse can be suppressed with hormone therapy,⁸ like with Lupron Depot, danazol or extended aeon accumulated articulate contraceptive pills.

Epidemiology

Some sources affirmation this article represents 3-6% of pneumothorax in women.⁸ In attention of the low incidence of primary ad-lib pneumothorax (i.e. not due to surgical agony etc.) in women (about 1/100'000/year),⁸ this is a actual attenuate condition. Hence, abounding basal textbooks don't acknowledgment it, and abounding doctors accept never heard of it. However, catamenial pneumothorax is apparently under-recognised.³

References

Review article: Alifano M, Trisolini R, Cancellieri A, Regnard JF. Thoracic endometriosis: accepted knowledge. Ann Thorac Surg 2006; 81: 761-9. PMID 16427904

1. ^ Definition from mercksource.com (Dorlands Medical Dictionary)
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3. ^ ^{a b} Alifano M, Roth T, Broet SC, Schussler O, Magdeleinat P, Regnard JF. Catamenial pneumothorax: a -to-be study. Chest 2003; 124: 1004-8. PMID 12970030
4. ^ Peikert T, Gillespie DJ, Cassivi SD. Catamenial pneumothorax. Mayo Clin Proc 2005; 80: 677-80.
5. ^ ^ a b Glynis D. Wallace. Living With Lung And Colon Endometriosis: Catamenial Pneumothorax. Authorhouse, 2005. ISBN 1-4208-8331-3
6. ^ Peikert T, Gillespie DJ, Cassivi SD (2005). "Catamenial pneumothorax: case address and analysis of the literature". Mayo Clinic Proceedings 80 (5): 677–680. PMID 15887438. 
7. ^ Poyraz AS, Kilic D, Hatipoglu A, Demirhan BA. A actual attenuate entity: catamenial pneumothorax. Asian Cardiovasc Thorac Ann 2005; 13:271-3. PMID 16113003
8. ^ ^{a b c} radio/563 at eMedicine